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490859
I
n~: DECLARATION OF DOMICILE
To the Clerk of the Circuit Court [County Comptrollers ST. L UGIE County, Florida. '
6 4
This is my declaration of domicile in the State of~ r/ G / ~'u~'d" that I am filing
this day in accordance and in conformity with Section ~ or aa-3'tatutes.
. Y
FOR ~OMICILZARIES OF THE STATE OF FLORIDA:
I hereby declare that I reside in and maintain a place of abode at f'S°~ ~~-?ri/~o2 f ,
~ ~ --ts ree~a-num~er'~-
Ff /"/~'R~
~ in ST. LUG 1 E County, Florida, which place. of abode I
ci y
recognize and intend to maintain as my permanent home and, if I maintain another place•or
places of abode in some other state or states, I hereby declare that my above-described 3
residence and abode in the State of Florida constitutes my predominant and principal home,
- and I intend to continue it permanently as such. I am, at the time of ing this declara-
tion, a bona fide resident of the State of Florida residing at ~sa9• ~Elv~A2~ D~~
~ street an n er'f-
/"~/,=/IG/_ , in s~, ~t{C/F_ County, Florida. I formerly resided at
city
ff~a Soiri So•~o2•lyis/E County, /~~ki O2 and the
city state -
place or places where I maintain another or other place or places of abode are as follows:
(Here list street address, city, county and state of any other place or places of abode.)
~N,~~~
dam- ~ _ 4~~
~
sign ure
Swo~•,.td .anx~;; sub~gribed before me this ~~day o A. D. 19
<•:-i'.. OGER POITRAS CLERK CIRCUIT COURT
` ~ ~ ~ ~ LUG I E COUNTY, FOR 1 DA t
Notary - ic, ~~o F on a at Large. -
1„~ ~ss~': g ~ DEPUTY CLERK
~ FOR%,~ILf~LY OF STATES OTHER THAN THE STATE DA:
er y •ai'e at my omlci a is 1n the State of and that I intend
to permanently continue .and maintain my domicile in suc state. At the time of making this
declaration I am a bona fide resident of the State of My place of
abode within the State of Florida, if any, is as follows: Here ist street address, city,
and county of place of abode in Flozida.)
s (Person making declaration may also include such other and further facts with reference to
any acts done or performed by such person which such person desires or intends not to be
construed as evidencing'any intention to establish his domicile within the State of Florida.)
~gao 2s ~ r a i
~ f IlEO ~H[' kECORi;E B
s S RO~G~R
POITRASA•
~LERIt CIRCUI? CiIJltT
RL;,LRD YEFIFiFQ__
signature
sworn to and subscribed before me this day of A. D. 19
notary is State o F on a at Large.
My Commission expires
IiR`~ PI16E~,~JrwJ
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